title: Hand hygiene behavior: translating behavioral research into infection control practice.
abstract: BACKGROUND
  In 2009, the World Health Organization (WHO) recommended "My Five Moments for Hand Hygiene" (5MHH) to optimize hand hygiene (HH). Uptake of these recommendations by healthcare workers (HCWs) remains uncertain.
  
  
  METHODS
  We prospectively observed HCW compliance to 5 MHH. After observations, eligible HCWs who consented to interviews completed surveys on factors associated with HH compliance based on constructs from the transtheoretical model of behavioral change (TTM) and the theory of planned behavior (TPB). Survey results were compared with observed HCW behaviors.
  
  
  RESULTS
  There were 968 observations among 123 HCWs, of whom 110 (89.4%) were female and 63 (51.3%) were nurses. The mean HH compliance for all 5 MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW 5 MHH compliance was associated with critical care unit encounters (P < .05), medicine unit encounters (P - 0.08, P < .001]), immunocompromised patient encounters (P < .05), and HCW prioritized patient advocacy (P < .001). Self-reported TTM stages of action or maintenance (P < .08) and the total TPB behavior score correlated with observed 5 MHH (r = 0.21, P < .02) and with self-reported 5 MHH compliance (r = 0.53, P < .001).
  
  
  CONCLUSIONS
  Observed HCW compliance to 5 MHH was associated with the type of hospital unit, type of provider-patient encounter, and theory-based behavioral measures of 5 MHH commitment.
authors.affiliation: Thammasat University Hospital, Pathumthani, Thailand.
authors.forename: Thanee
authors.initials: T
authors.lastname: Eiamsitrakoon
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Winitra
authors.initials: W
authors.lastname: Nuallaong
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006757:Hospital Units; D006801:Humans; D008297:Male; D019370:Observation; D010564:Personnel, Hospital / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011582:Psychological Theory; D057566:Self Report